Etnoenfermería y teoría del cuidado cultural, evidencias metodológicas en la investigación en enfermería: una revisión integrativa

Introducción: La atención en salud involucra aspectos culturales que deben conocerse para beneficiar a las personas desde el cuidado de enfermería. Objetivo: Describir el uso de la etnoenfermería como diseño de investigación y la teoría del cuidado cultural de Madeleine Leininger en la literatura de enfermería. Metodología: Se realizó una revisión integrativa bajo las fases de Withmoore y Knalf. La búsqueda bibliográfica se llevó a cabo en Medline, Cuiden Plus, Lilacs, Scopus y ScienceDirect, con los descriptores "investigación cualitativa", "enfermería", "asistencia sanitaria culturalmente competente" y "enfermería transcultural" en idioma inglés, español, portugués, incluyendo artículos originales publicados entre 2013 a 2023. Resultados: Se eligieron 12 artículos que fueron codificados para el surgimiento de cuatro categorías: necesidad de formación en etnoenfermería y teoría del cuidado de la cultura; reconocimiento del contexto cultural y barreras para el cuidado culturalmente congruente; diversidad y universalidad de los cuidados culturales; y acciones para el cuidado culturalmente congruente. Conclusiones: La revisión permitió reconocer que la teoría de cuidado cultural y la etnoenfermería han sido escasamente utilizadas en la práctica científica y profesional de enfermería. Es necesario incentivar en los profesionales la importancia de valorar el respeto por las diferentes culturas en los servicios de salud.

Introdução: O atendimento em saúde envolve aspectos culturais que devem ser conhecidos para beneficiar as pessoas a partir dos cuidados de enfermagem. Objetivo: Descrever a utilização da etnoenfermagem como desenho de investigação e a teoria cultural do cuidado de Madeleine Leininger na literatura de enfermagem. Métodos: Foi efetuada uma revisão integrativa segundo as fases de Withmoore e Knalf. A pesquisa bibliográfica foi realizada nas bases de dados Medline, Cuiden Plus, Lilacs, Scopus e ScienceDirect, com os descritores "pesquisa qualitativa", "enfermagem", "assistência à saúde culturalmente competente" e "enfermagem transcultural" em inglês, espanhol e português, incluindo artigos originais publicados entre 2013 a 2023. Resultados: Selecionou-se 12 artigos, codificados para o surgimento de quatro categorias: necessidade de formação em etnoenfermagem e teoria cultural do cuidado; reconhecimento do contexto cultural e barreiras para o cuidado culturalmente congruente; diversidade e universalidade do cuidado cultural; e ações para o cuidado culturalmente congruente. Conclusões: A revisão permitiu reconhecer que a teoria dos cuidados culturais e a etnoenfermagem têm sido escassamente utilizadas na prática científica e profissional da enfermagem. É necessário incentivar nos profissionais a importância de valorizar o respeito pelas diferentes culturas nos serviços de saúde..

Introduction: Health care involves cultural aspects that must be known to benefit people from the Nursing care provided. Objective: To describe the use of Ethnonursing as a research design and Madeleine Leininger's Theory of Culture Care in the Nursing literature. Methods: n integrative review was carried out following the phases proposed by Withmoore and Knalf. The bibliographic search was conducted in Medline, Cuiden Plus, Lilacs, Scopus and ScienceDirect. The "qualitative research", "nursing", "culturally competent health care" and "transcultural nursing" descriptors were used in English, Spanish and Portuguese, including original articles published between 2013 and 2023. Results: A total of 12 articles were chosen and coded to give rise to four categories, namely: need for training in Ethnonursing and in the Theory of Culture Care; recognition of the cultural context and of barriers to culturally congruent care; culture care diversity and universality; and actions for culturally congruent care. Conclusions: The review allowed recognizing that the Theory of Culture Care and Ethnonursing have been scarcely used in the scientific and professional Nursing practice. It is necessary to encourage professionals to value due respect for different cultures in health services.

Proyecciones del cuidado disciplinar de enfermería desde la filosofía de Jean Watson: una revisión sistemática

Introducción: La historia del cuidado de enfermería ha transitado cuatro etapas: doméstica, vocacional, técnica y profesional, que han sido fundamentales en su desarrollo. Sin embargo, los actuales desafíos sociosanitarios ponen de manifiesto la necesidad de proyectar nuevas etapas. Objetivo: Proyectar el futuro del cuidado de enfermería a la luz de la filosofía y teoría de los cuidados transpersonales de Jean Watson. Metodología: Se realizó una revisión sistemática y un análisis crítico-reflexivo sobre las proyecciones disciplinares de la enfermería. La revisión abarcó artículos publicados hasta 2023 en Web of Science, LILACS, SciELO y CINAHL. Se encontraron 366 artículos, de los cuales 8 cumplieron con los criterios de elegibilidad. El análisis crítico-reflexivo se centró en describir la evolución de las etapas y en proponer una etapa futura. Resultados: El cuidado humanizado es un proceso complejo que requiere de habilidades de comunicación específicas, no solo entre profesionales de la salud, sino también con los usuarios y sus familias. A su vez, el cuidado humanizado se integra a un entorno clínico desafiante, debido a la alta carga laboral, la disponibilidad limitada de recursos y la necesidad de mantener un nivel competitivo en la práctica profesional. Se propone como quinta etapa el "cuidado disciplinar de enfermería". Conclusiones: Esta nueva etapa se centraría en la gestión del cuidado y en el cuidado humanizado mediante un perfeccionamiento de la investigación, la formación continua, los modelos y teorías, y la autonomía profesional

Introdução: A história do cuidado na enfermagem passou por quatro etapas: doméstica, vocacional, técnica e profissional, que foram fundamentais para seu desenvolvimento. No entanto, os atuais desafios sociossanitários destacam a necessidade de projetar novas etapas. Objetivo: Projetar o futuro do cuidado de enfermagem à luz da filosofia e da teoria dos cuidados transpessoais de Jean Watson. Metodologia: Foi realizada uma revisão sistemática e uma análise crítico-reflexiva sobre as projeções disciplinares da enfermagem. A revisão abrangeu artigos publicados até 2023 nas bases Web of Science, LILACS, SciELO e CINAHL. Foram encontrados 366 artigos, dos quais 8 atenderam aos critérios de elegibilidade. A análise crítico-reflexiva concentrou-se em descrever a evolução das etapas e propor uma etapa futura. Resultados: O cuidado humanizado é um processo complexo que exige habilidades específicas de comunicação, não apenas entre os profissionais de saúde, mas também com os usuários e seus familiares. Por sua vez, o cuidado humanizado está integrado em um ambiente clínico desafiador, devido à alta carga de trabalho, disponibilidade limitada de recursos e à necessidade de manter um nível competitivo na prática profissional. Propõe-se como quinta etapa o "cuidado disciplinar de enfermagem". Conclusões: Esta nova etapa se concentraria no gerenciamento do cuidado e no cuidado humanizado por meio do aperfeiçoamento da pesquisa, da formação continuada, dos modelos e teorias e da autonomia profissional

Introduction: The history of nursing care has passed through four stages: domestic, vocational, technical and professional, which have been fundamental in its development. However, current socio-sanitary challenges demonstrate the need to plan new steps. Objective: Project the future of nursing care in the light of the philosophy and theory of transpersonal care by Jean Watson. Methodology: A systematic review and critical-reflexive analysis of nursing disciplinary projections was carried out. The review covers articles published until 2023 in Web of Science, LILACS, SciELO and CINAHL. There will be 366 articles, of which 8 met the eligibility criteria. The critical-reflexive analysis focuses on describing the evolution of the stages and proposing a future stage. Results: Humanized care is a complex process that requires specific communication skills, both between healthcare professionals and users and their families. In turn, humanized care is integrated into a challenging clinical environment, due to the high workload, limited availability of resources and the need to maintain a competitive level in professional practice. "Disciplinary nursing care" is proposed as a fifth stage. Conclusions: This new stage will focus on care management and humanized care through perfecting research, continued training, models and theories, and professional autonomy

Beyond Role Conflict and Ambiguity: A Global Measure of Role Stress among South African School Teachers / Más allá del conflicto y la ambigüedad de roles: una medida global del estrés de rol entre los profesores sudafricanos

Abstract Background: Role stress is linked to reduced work performance, diminished organizational commitment, increased intention to leave a job, and negative physical and mental health effects. Given the significant implications of role stress, researchers have sought to understand and quantify the concept. The Role Conflict and Ambiguity (RCA) scales are widely utilized in job stress research as the predominant measurement tools. They were originally conceptualized as consisting of two independent dimensions: role conflict and role ambiguity. Objective: This study advances the validation research of the RCA scales by exploring its dimensionality through Mokken Scale Analysis (MSA) and Classical Test Theory (CTT). Method: South African school teachers responded to the RCA scales, Maslach Burnout Inventory, and Teaching Satisfaction Scale. Confirmatory Factor Analysis (CFA) and MSA were employed for data analysis. Results: The research determined that a second-order model provided the optimal fit, indicating that role ambiguity and role conflict are subordinate dimensions within the overarching construct of role stress. Conclusion: The findings from the CFA and supplementary bifactor indices reinforce the view that the instrument comprises 13 items, which assess a general dimension of role stress along with two sub-dimensions: role conflict and role ambiguity. Such specificity may lead to more effective strategies to mitigate role-related stress, thereby enhancing overall employee well-being, job satisfaction, and organizational productivity.

Resumen Antecedentes: El estrés de rol está relacionado con la reducción del rendimiento laboral, la disminución del compromiso organizativo, el aumento de la intención de abandonar el trabajo y los efectos negativos sobre la salud física y mental. Dadas las importantes implicaciones del estrés de rol, los investigadores han tratado de comprender y cuantificar este concepto. Las escalas de Conflicto y Ambigüedad de Roles (RCA) se utilizan ampliamente en la investigación del estrés laboral como herramientas de medición predominantes. Al principio, se conceptualizaron como dos dimensiones independientes: conflicto de rol y ambigüedad de rol. Objetivo: Este estudio avanza en la investigación de validación de las escalas RCA, explorando su dimensionalidad mediante el Análisis de Escalas de Mokken (MSA) y la Teoría Clásica de los Test (CTT). Método: Profesores sudafricanos respondieron a las escalas RCA, Maslach Burnout Inventory y Teaching Satisfaction Scale. Se emplearon el Análisis Factorial Confirmatorio (AFC) y el MSA para el análisis de los datos. Resultados: La investigación determinó que un modelo de segundo orden proporcionaba el ajuste óptimo, indicando que la ambigüedad de rol y el conflicto de rol son dimensiones subordinadas dentro del constructo global del estrés de rol. Conclusiones: Los resultados del AFC y los índices bifactoriales suplementarios refuerzan la opinión de que el instrumento consta de 13 ítems, que evalúan una dimensión general de estrés de rol junto con dos subdimensiones: conflicto de rol y ambigüedad de rol. Esta especificidad puede conducir a estrategias más eficaces para mitigar el estrés relacionado con el rol, mejorando así el bienestar general de los empleados, la satisfacción en el trabajo y la productividad de la organización.

Evidence of validity of a Jealousy Scale in Peruvian youth and adults: An item response theory approach / Evidencia de validez de una Escala de Celos en jóvenes y adultos peruanos: un enfoque de teoría de respuesta al ítem

Abstract Introduction/Objective: In romantic relationships, jealousy can influence how individuals feel emotionally and interact with their partners. This study analysed the metric properties of the Brief Jealousy Scale (BJS) in young adults from Peru using current methods. Method: A total of 297 individuals were selected to participate in the study. They averaged 26.52 years of age (with a variation of 7.75 years), and 74.10% were women. The study used a technique called Item Response Theory (IRT) with a two-parameter model to confirm the structure and reliability of the BJS. Result: The BJS demonstrated high reliability and fit through goodness-of-fit indices. DIF analysis indicated slight gender biases in some items, reflecting differences in the perception of jealousy between men and women. Conclusions: The study highlights the importance and usefulness of the Jealousy Scale in relationships, as it helps to understand relationship dynamics and guides interventions. Future studies should address issues such as participant selection and study design and examine whether the scale can be used in different cultures.

Resumen Introducción/Objetivo: En las relaciones de pareja, los celos pueden influir en cómo se sienten emocionalmente y en cómo interactúan las personas con su pareja. Este estudio analizó las propiedades métricas de la Escala Breve de Celos en jóvenes y adultos de Perú utilizando métodos actuales. Método: Se seleccionaron 297 personas para participar en el estudio. Tenían en promedio 26.52 años (con una variación de 7.75 años) y el 74.10 % eran mujeres. El estudio utilizó una técnica llamada teoría de respuesta al ítem (IRT) con un modelo de dos parámetros para confirmar la estructura y fiabilidad del BJS. Resultados: El BJS demostró una gran confiabilidad y ajuste a través de índices de bondad de ajuste. El análisis DIF indicó ligeros sesgos de género en algunos ítems, lo que refleja diferencias en la percepción de los celos entre hombres y mujeres. Conclusiones: El estudio resalta la importancia y utilidad de la Escala de Celos en las relaciones, ya que ayuda a entender cómo funcionan y a saber cómo intervenir. En el futuro, los estudios deben ocuparse de problemas como la selección de participantes y el tipo de estudio realizado, y examinar si la escala se puede usar en diferentes culturas.

Actitudes ante la muerte en profesionales de enfermería latinoamericanos: una revisión integrativa

Introducción: La muerte es parte de los tabúes sociales existentes y puede fomentar actitudes que distan de su abordaje explícito en relación con los cuidados. Objetivo: Analizar las actitudes ante la muerte en profesionales de enfermería de acuerdo con las publicaciones científicas en el contexto latinoamericano en el período 2018 a 2022. Metodología: Se realizó una revisión de literatura integrativa de las publicaciones científicas latinoamericanas respecto de las actitudes ante la muerte en el contexto de la enfermería, empleando los siguientes términos estandarizados: actitud, muerte, enfermería y cuidados de enfermería. Se incluyeron 8 artículos publicados en el período definido, en idioma español y portugués, en los que se abordó explícitamente la temática de la revisión. La información de los artículos fue analizada tomando como referencia los conceptos de la teoría de las transiciones. Resultados: Se encontraron diseños tanto cuantitativos (50 %) como cualitativos (50 %), elaborados en su totalidad en el ámbito hospitalario. Los principales resultados dan cuenta del predominio de la indiferencia ante la muerte en el contexto de los cuidados. En relación con la teoría de las transiciones, la mayoría de los artículos abordan las condiciones en que estas se dan, además de los conceptos de terapéutica de enfermería y patrones de respuesta. Conclusiones: La producción de investigaciones sobre la actitud ante la muerte en profesionales de enfermería es escasa en Latinoamérica. Las experiencias de pérdidas cercanas, la capacitación y el soporte institucional son la base para contribuir a una mejor actitud hacia la muerte

Introdução: A morte faz parte dos tabus sociais existentes e pode fomentar atitudes que se distanciam de sua abordagem explícita em relação aos cuidados. Objetivo: analisar as atitudes diante da morte em profissionais de enfermagem de acordo com as publicações científicas no contexto latino-americano no período de 2018 a 2022. Metodologia: Foi realizada uma revisão de literatura integrativa de publicações científicas latino-americanas sobre atitudes diante da morte no contexto da enfermagem, utilizando os seguintes termos padronizados: atitude, morte, enfermagem e cuidados de enfermagem. Foram incluídos 8 artigos publicados no período definido, em espanhol e português, nos quais o tema da revisão foi abordado explicitamente. As informações dos artigos foram analisadas tendo como referência os conceitos da teoria das transições. Resultados: Foram identificados desenhos quantitativos (50 %) e qualitativos (50 %), elaborados totalmente no âmbito hospitalar. Os principais resultados mostram a predominância da indiferença diante da morte no contexto do cuidado. Em relação à teoria das transições, a maioria dos artigos aborda as condições em que as transições ocorrem, além dos conceitos de terapêutica de enfermagem e padrões de resposta. Conclusões: A produção de pesquisas sobre atitudes diante da morte em profissionais de enfermagem é escassa na América Latina. As experiências de perdas próximas, a capacitação e o apoio institucional são a base para contribuir para uma melhor atitude em relação à morte

Introduction: Death is part of the existing social taboos and can foster attitudes that are far from its explicit approach in relation to care. Objective: To analyze attitudes towards death in nursing professionals according to scientific publications in the Latin American context in the period 2018 to 2022. Methodology: An integrative literature review was conducted of Latin American scientific publications regarding attitudes towards death in the context of Nursing, using the following standardized terms: attitude, death, nursing and nursing care. Eight articles published in the defined period were included, in Spanish and Portuguese, in which the subject of the review was explicitly addressed. The information in the articles was analyzed using the concepts of the theory of transitions as a reference. Results: Both quantitative (50 %) and qualitative (50 %) designs were found, all of them elaborated in the hospital setting. The main results show the predominance of indifference to death in the context of care. In relation to the theory of transitions, most of the articles address the conditions under which these occur, in addition to the concepts of nursing therapeutics and response patterns. Conclusions: The production of research on the attitude towards death in nursing professionals is scarce in Latin America. Experiences of close losses, training and institutional support are the basis for contributing to a better attitude towards death

A DFT study of the effect of hydrostatic pressure on the structure and electronic properties of sarcosine crystal.

CONTEXT: We perform density functional theory calculations to study the dependence of the structural and electronic properties of the amino acid sarcosine crystal structure on hydrostatic pressure application. The results are analyzed and compared with the available experimental data. Our findings indicate that the crystal structure and properties of sarcosine calculated using the Grimme dispersion-corrected PBE functional (PBE-D3) best agree with the available experimental results under hydrostatic pressure of up to 3.7 GPa. Critical structural rearrangements, such as unit cell compression, head-to-tail compression, and molecular rotations, are investigated and elucidated in the context of experimental findings. Band gap energy tuning and density of state shifts indicative of band dispersion are presented concerning the structural changes arising from the elevated pressure. The calculated properties indicate that sarcosine holds great promise for application in electronic devices that involve pressure-induced structural changes. METHODS: Three widely used generalized gradient approximation functionals-PBE, PBEsol, and revPBE-are employed with Grimme's D3 dispersion correction. The non-local van der Waals density functional vdW-DF is also evaluated. The calculations are performed using the projector-augmented wave method in the Quantum Espresso software suite. The geometry optimization results are visualized using VMD. The Multiwfn and NCIPlot programs are used for wavefunction and intermolecular interaction analyses.

Adsorption grand potential of OH on metal oxide surfaces.

CONTEXT: Describing chemical processes at solid-liquid interfaces as a function of a fixed electron chemical potential presents a challenge for electronic structure calculations and is essential for understanding electrochemical phenomena. Grand Canonical Density Functional Theory (GCDFT) allows treating solid-liquid interfaces in such a way that studying the influence of a fixed electron potential arises naturally. In this work, GCDFT is used to compute the adsorption grand potential (AGP), a key parameter for understanding and predicting the behavior of adsorbates on surfaces. We focused on the adsorption of an OH molecule on three metallic surfaces commonly used in electrochemical processes, such as the oxygen evolution reaction (OER). Our study aims to offer insights into how AGP can be used to compare adsorption strengths under different fixed electron chemical potentials, which is crucial for designing efficient electrode materials. By determining the average number of electrons self-consistently under varying chemical potentials, we showed how one can distinguish between electron acquisition and depletion during the adsorption process, offering a deeper understanding of the adsorbate-surface interactions. METHODS: The approach used in this work employs the Kohn-Sham-Mermin formulation of the Grand Canonical Density Functional Theory. The computations were performed using the periodic open-source density functional theory software, JDFTx, with the Garrity-Bennett-Rabe-Vanderbilt library of ultrasoft pseudopotentials. Calculations were made using truncated Coulomb potentials and the auxiliary Hamiltonian method with the PBE exchange-correlation functional, along with DFT-D2 long-range dispersion corrections. The implicit solvation model CANDLE was used to describe the electrolyte with a 1 M concentration.

Introducing KICK-MEP: exploring potential energy surfaces in systems with significant non-covalent interactions.

CONTEXT: Exploring potential energy surfaces (PES) is fundamental in computational chemistry, as it provides insights into the relationship between molecular energy, geometry, and chemical reactivity. We introduce Kick-MEP, a hybrid method for exploring the PES of atomic and molecular clusters, particularly those dominated by non-covalent interactions. Kick-MEP computes the Coulomb integral between the maximum and minimum electrostatic potential values on a 0.001 a.u. electron density isosurface for two interacting fragments. This approach efficiently estimates interaction energies and selects low-energy configurations at reduced computational cost. Kick-MEP was evaluated on silicon-lithium clusters, water clusters, and thymol encapsulated within Cucurbit[7]uril, consistently identifying the lowest energy structures, including global minima and relevant local minima. METHODS: Kick-MEP generates an initial population of molecular structures using the stochastic Kick algorithm, which combines two molecular fragments (A and B). The molecular electrostatic potential (MEP) values on a 0.001 a.u. electron density isosurface for each fragment are used to compute the Coulomb integral between them. Structures with the lowest Coulomb integral are selected and refined through gradient-based optimization and DFT calculations at the PBE0-D3/Def2-TZVP level. Molecular docking simulations for the thymol-Cucurbit[7]uril complex using AutoDock Vina were performed for benchmarking. Kick-MEP was validated across different molecular systems, demonstrating its effectiveness in identifying the lowest energy structures, including global minima and relevant local minima, while maintaining a low computational cost.

Limited open information sharing and mobility promotes sustainability of jaguar tourism in Pantanal wetland, Brazil.

Wildlife tourism plays a crucial role in biodiversity conservation. However, long-term sustainability is difficult to achieve. In this paper, we use property theory to produce a mathematical model that aims to better support stakeholders from the wildlife tourism industry to better guarantee a balance between sightings probability, tourists' overall experience and operators' sharing behaviour. We illustrate our model with the case study of Porto Jofre in the Pantanal wetland, Brazil. We show that while dealing with low sighting probability, tourist operators must share information about species' locations, leading to a system of open access regarding mobility and information. However, when sightings become common, sharing must be restricted to a bounded group avoiding overcrowding, a system of limited open access. Finally, when the sighting probability is high, no sharing is needed to achieve maximum overall experience. Our case study in Porto Jofre, Pantanal, Brazil, clearly shows these shifts in terms of governance strategies. We show that by looking at sighting probability it is possible to predict the best optimal social strategy that will guarantee long-term sustainability of the wildlife tourism initiatives. We also show the need for external support on adaptation in cases where current strategies do not match the predicted ones.

Maintaining exercise in fitness centre settings: insights from the physical activity maintenance theory.

PURPOSE: This study examines factors that influence long-term fitness centre participation, applying the Physical Activity Maintenance Theory to assess psychological and contextual influences on exercise adherence. METHODS: Semi-structured interviews were conducted with 17 regular fitness centre attendees in Taubaté, São Paulo, Brazil. Data were analysed using Bardin's Content Analysis, exploring the participants' experiences and the factors contributing to their sustained activity. RESULTS: Autonomous motivation, such as enjoyment and satisfaction from workouts, along with self-efficacy, emerged as crucial for continued fitness centre attendance. The environment, including ambiance, social support, and facility quality, significantly impacted exercise persistence. However, challenges like time constraints, weather conditions, and personal issues occasionally hindered engagement. The study also highlights the role of personalized fitness programmes in supporting long-term adherence, suggesting that tailoring these programmes to individual goals could further enhance commitment. CONCLUSIONS: The findings underscore the importance of fitness centres creating environments that align with individual needs and preferences. Customized programmes that cater to both personal and communal needs could bolster long-term adherence. Future research should explore the impact of personalized, community-integrated fitness approaches on sustaining active lifestyles, emphasizing the importance of accommodating individual preferences in maintaining regular exercise habits.

Integrating frontiers: a holistic, quantum and evolutionary approach to conquering cancer through systems biology and multidisciplinary synergy.

Cancer therapy is facing increasingly significant challenges, marked by a wide range of techniques and research efforts centered around somatic mutations, precision oncology, and the vast amount of big data. Despite this abundance of information, the quest to cure cancer often seems more elusive, with the "war on cancer" yet to deliver a definitive victory. A particularly pressing issue is the development of tumor treatment resistance, highlighting the urgent need for innovative approaches. Evolutionary, Quantum Biology and System Biology offer a promising framework for advancing experimental cancer research. By integrating theoretical studies, translational methods, and flexible multidisciplinary clinical research, there's potential to enhance current treatment strategies and improve outcomes for cancer patients. Establishing stronger links between evolutionary, quantum, entropy and chaos principles and oncology could lead to more effective treatments that leverage an understanding of the tumor's evolutionary dynamics, paving the way for novel methods to control and mitigate cancer. Achieving these objectives necessitates a commitment to multidisciplinary and interprofessional collaboration at the heart of both research and clinical endeavors in oncology. This entails dismantling silos between disciplines, encouraging open communication and data sharing, and integrating diverse viewpoints and expertise from the outset of research projects. Being receptive to new scientific discoveries and responsive to how patients react to treatments is also crucial. Such strategies are key to keeping the field of oncology at the forefront of effective cancer management, ensuring patients receive the most personalized and effective care. Ultimately, this approach aims to push the boundaries of cancer understanding, treating it as a manageable chronic condition, aiming to extend life expectancy and enhance patient quality of life.

Strategies Used by Puerto Rican Children in the Cognitive Assessment System and Their Relationship with Planning Performance.

Studies involving the Cognitive Assessment System (CAS) planning scale typically use only the subtest and scale scores without assessing the strategies employed by the participants. This study addressed this gap and examined the planning strategies used by children in the CAS2: Spanish version and their relationship with planning performance. We conducted an exploratory cross-sectional study with 26 Puerto Rican children aged 8 to 11. Results showed that no strategies were consistently used by participants according to examinees' reports (f = 0-46%), but examiners observed consistent use of some strategies such as "coded left to right, top to bottom", f = 92%; "scanned the page for the next number or letter", f = 100%. Welch's t-tests did not show relationships between participants' performance and the strategies observed by examiners, | mean differences | = 0.05-0.81, ps ≥ 0.05, nor with the strategies reported by participants, | mean differences | = 0.05-1.69, ps ≥ 0.05. These findings suggest that although the examiners may observe the use of strategies, the examinees are unaware of the strategies they use, and the strategies used are not associated with their performance. Future studies are needed to confirm these findings.

Exploring the optical behavior and relative translucency parameter of CAD-CAM resin-based composites, polymer-infiltrated ceramic network, and feldspar porcelain.

OBJECTIVES: To evaluate and compare the optical properties and relative translucency parameter of CAD-CAM restorative materials. METHODS: Four CAD-CAM materials were evaluated: Lava Ultimate (LU), Grandio Blocs (GB), VITA Enamic (VE), and VITA Mark II (VM). Disk-shaped samples in shade A2-HT were prepared (n = 10) and polished to 1.00 ± 0.01 mm of thickness. Scattering (S), absorption (K), albedo (a) coefficient, transmittance (T%), light reflectivity (RI), infinite optical thickness (X∞), and radiative transfer coefficients (µa, and µ'S) were calculated using Kubelka-Munk method and Thennadil's semi-empirical approach. Root Mean Square Error (RMSE) and Goodness of Fit (GFC) were used as performance optical behavior. Translucency differences were evaluated using the relative translucency parameter (RTP00) and 50:50 % translucency perceptibility and acceptability thresholds (TPT00 and TAT00). RESULTS: The spectral distribution of S, K, T%, RI, and X∞ was wavelength-dependent. GFC and RMSE values indicated good spectral behavior matches and good comparative spectral values for RI in LU-GB, LU-VE, and GB-VE, and for K in VE-VM. VM displayed the highest scattering values across the wavelengths, while VE and VM showed lower absorption at shorter wavelengths. LU and GB had the highest transmittance. The X∞ values indicated that all 1.0 mm thick materials could be influenced by the background. No good spectral match and no good comparative spectral values were found between CAD-CAM materials and anterior bovine maxillary specimens. VM had the lowest RTP00 values with perceptible and unacceptable differences compared to CAD-CAM materials evaluated. SIGNIFICANCE: Understanding the optical behavior of different CAD-CAM materials was essential for guiding clinicians in material selection and optimizing their clinical performance. The findings confirm that the different compositions and microstructure impact the optical properties and translucency of CAD-CAM restorative materials.

Improvement in antibacterial use in intensive care units from Argentina: A quality improvement collaborative process evaluation using Normalization Process Theory.

BACKGROUND: Healthcare-associated infections and antibiotic resistance worsen globally. Antibiotic stewardship programs (ASP) aim to optimise infection treatment and curb resistance, yet implementation hurdles persist. This study examined ASP challenges in ICUs. METHODS: This study employed a qualitative methodological design to evaluate the implementation process of an antibiotic stewardship program (ASP) in eight intensive care units (ICUs) across Argentina. Thirty-four semi-structured interviews with healthcare workers (HCWs) were conducted. Interviews were analysed guided by Normalisation Process Theory, examining coherence, cognitive participation, collective action, and reflexive monitoring constructs. RESULTS: Key challenges included insufficient human resources, lack of institutional support, and resistance to change, particularly among staff not initially involved in the study. Despite these challenges, the program saw partial success in improving ICU practices, particularly in antibiotic use and communication across departments. The main strategy implemented in this quality improvement collaborative was the use of improvement cycles, which served as the central component for driving change. However, participation in improvement cycles was inconsistent, and sustainability post-intervention remains uncertain due to workload pressures and the need for continuous education. Concerns about workload and communication barriers persisted. Many participants did not perceive training as a separate component, which led to low engagement. Resistance to change became evident during modifications to clinical guidelines. The intervention had a positive impact on various processes, including communication and record keeping. CONCLUSION: This study underscores the persistent challenges in implementing ASPs in healthcare, emphasising the need for enhanced collaboration, workforce capacity building, and evidence-based practices to overcome barriers and optimize antimicrobial use to improve patient outcomes.

Kidney transplantation outcomes: Is it possible to improve when good results are falling down?

Famure et al describe that close to 50% of their patients needed early or very early hospital readmissions after their kidney transplantation. As they taught us the variables related to those outcomes, we describe eight teaching capsules that may go beyond what they describe in their article. First two capsules talk about the ideal donors and recipients we should choose for avoiding the risk of an early readmission. The third and fourth capsules tell us about the reality of cadaveric donors and recipients with comorbidities, and the way transplant physicians should choose them to maximize survival. Fifth capsule shows that any mistake can result in an early readmission, and thus, in poorer outcomes. Sixth capsule talks about economic losses of early readmissions, cost-effectiveness of transplantation, and how to improve outcomes and reduce costs by managing a risky patient-portfolio. Seventh capsule argues about knowing your risk behavior to better manage your portfolio; and Eighth capsule about the importance of the center experience in transplanting complex patients. We finish with some lessons of the importance of the transplantation process and the collaboration with other disciplines in order to prevent the conditions that lead to early readmissions.

Pre-natal and early life lead exposure and childhood inhibitory control: an item response theory approach to improve measurement precision of inhibitory control.

BACKGROUND: Neurodevelopmental performance tasks are often separately analyzed, even when they tap into a similar construct. This may yield mixed findings for associations of an exposure-neurobehavioral outcome. We develop an item response theory (IRT) approach to integrate multiple task variables together to improve measurement precision of the underlying construct. We apply this approach to create an integrative measure of childhood inhibitory control, and study impacts of pre/post-natal lead exposure. METHODS: Using data from a prospective cohort based in Mexico (N = 533), we created an inhibitory control scale that integrates accuracy and reaction time information from four inhibitory control tasks (Go/NoGo Letter, Go/NoGo Neutral, Go/NoGo Happy, Delis-Kaplan Executive Function System (D-KEFS) Color-Word Interference Test, Condition 3). Using a generalized partial credit item response theory model, we estimated an inhibitory control index for each participant. We then assessed adjusted associations between umbilical cord blood and 4-year lead and childhood inhibitory control. We developed a resampling approach to incorporate error estimates from the inhibitory control variable to confirm the consistency of the lead-inhibitory control associations. We modeled time-varying associations of lead with each inhibitory control measure separately. RESULTS: Participants had a median age of 9 years; 51.4% were males. Umbilical cord blood [-0.06 (95% CI: -0.11, -0.01)] and 4-year lead [-0.07 (95% CI: -0.12, -0.02)] were associated with inhibitory control index at 8-10 years. A resampling approach confirmed that 4-year lead was consistently associated with childhood inhibitory control index. Umbilical cord blood and 4-year lead were each associated with 3 out of 8 measures in separate models. CONCLUSION: This is the first application of IRT in environmental epidemiology to create a latent variable for inhibitory control that integrates accuracy and reaction time information from multiple, related tasks. This framework can be applied to other correlated neurobehavioral assessments or other phenotype data.

Effect of Terminal Hydroxy Groups on the Structural Properties of Acyl Thioureas.

The 1-acyl thiourea family [R1C(O)NHC(S)NR2R3] exhibits the flexibility to incorporate a wide variety of substituents into their structure. The structural attributes of these compounds are intricately tied to the type and extent of substitution. In the case of 3-mono-substituted thioureas (R2=H), the conformational behavior is predominantly shaped by the presence of an intramolecular N-H ⋅ ⋅ ⋅ O=C hydrogen bond. This study delves into the structural consequences stemming from the inclusion of substituents possessing hydrogen-donor capabilities within four novel 1-acyl-3-mono-substituted thiourea derivatives. A comprehensive suite of analytical techniques, encompassing FTIR, Raman spectroscopy, multinuclear (1H and 13C) NMR spectroscopy, single-crystal X-ray diffraction, and supported by computational methods, notably NBO (Natural Bond Orbital) population analysis, Hirshfeld analysis, and QTAIM (Quantum Theory of Atoms in Molecules), was harnessed to scrutinize and characterize these compounds. In the crystalline state, these compounds exhibit an intricate interplay of intermolecular interactions, prominently featuring an expansive network of hydrogen bonds between the hydroxy (-OH) groups and the carbonyl and thiocarbonyl bonds within the 1-acyl thiourea fragment. Notably, the topological analysis underscores significant distinctions in the properties of the acyl thiourea fragment and the intramolecular >C=O ⋅ ⋅ ⋅ H-N bond when transitioning from the isolated molecule to the crystalline environment.

"Pray Observe How Time Slips By:" Collaborators, Assistants, and the Background Dynamics in the Publication of Darwin's Cirripedia Project.

This study investigates nineteenth century natural history practices through the lens of the Actor-Network Theory, which posits that scientific practice is shaped by an intricate network of interactions between human and non-human actors. At the core of this research is the analysis of correspondence between Charles Darwin and his collaborators during the Cirripedia Project, which unveils a complex landscape of negotiations with illustrators, funders, specimen owners, and translators, among other stakeholders and interested parties. The study goes beyond the final outcomes of scientific research, delving into behind-the-scenes interactions, and hidden constructions, shedding light on the complex dynamics and actors that conventional scientific narratives often overlook. In general, this approach provides a detailed and insightful view of the underlying processes of nineteenth-century scientific practice, underscoring the importance of epistolary correspondence as a central element in producing scientific knowledge at the time, and in particular it reveals to us how much Darwin was himself involved in the production of his famous work on barnacles. By emphasizing the intricacies of research, this study enriches our understanding of Darwin's work as well as natural history practices in the 19th century, highlighting the complexity and diversity of actors and agents involved in shaping scientific knowledge.

Correlation between Molecular Docking and the Stabilizing Interaction of HOMO-LUMO: Spirostans in CHK1 and CHK2, an In Silico Cancer Approach.

Checkpoint kinases 1 and 2 (CHK1 and CHK2) are enzymes that are involved in the control of DNA damage. At the present time, these enzymes are some of the most important targets in the fight against cancer since their inhibition produces cytotoxic effects in carcinogenic cells. This paper proposes the use of spirostans (Sp), natural compounds, as possible inhibitors of the enzymes CHK1 and CHK2 from an in silico analysis of a database of 155 molecules (S5). Bioinformatics studies of molecular docking were able to discriminate between 13 possible CHK1 inhibitors, 13 CHK2 inhibitors and 1 dual inhibitor for both enzymes. The administration, distribution, metabolism, excretion and toxicity (ADMETx) studies allowed a prediction of the distribution and metabolism of the potential inhibitors in the body, as well as determining the excretion routes and the appropriate administration route. The best inhibition candidates were discriminated by comparing the enzyme-substrate interactions from 2D diagrams and molecular docking. Specific inhibition candidates were obtained, in addition to studying the dual inhibitor candidate and observing their stability in dynamic molecular studies. In addition, Highest Occupied Molecular Orbital-Lowest Unoccupied Molecular Orbital (HOMO-LUMO) interactions were analyzed to study the stability of interactions between the selected enzymes and spirostans resulting in the predominant gaps from HOMOCHKs to LUMOSp (Highest Occupied Molecular Orbital of CHKs-Lowest Unoccupied Molecular Orbital of spirostan). In brief, this study presents the selection inhibitors of CHK1 and CHK2 as a potential treatment for cancer using a combination of molecular docking and dynamics, ADMETx predictons, and HOMO-LUMO calculation for selection.

Certification exams evaluated with serial case reports: theoretical and problematic approach.

The objective of this issue is a theoretical approach to the disadvantages involved in taking the certification exams of medical specializations through serial case reports and analyzing them with the Classical Test Theory (TCT). The certification exams of medical specializations correspond to criterial summative exams with high consequences. Therefore, it is imperative to maintain the highest quality standards in all the processes involved in preparing the exam. At present, it has been detected that some councils of medical specialties conduct the certification exams with tests that contain serial case reports and the psychometric analysis that they conduct is supported by the TCT; however, the structure of this type of test violates the fundamental assumptions of the TCT. The violation of the fundamental assumptions of the TCT in the tests constructed through serial case reports can lead to biases or misinterpretations of the results. Due to the above, it is advisable to use other psychometric models for the analysis of this type of test, or to avoid the use of serial case reports in the certification exams of medical specialties.

Se presenta un planteamiento teórico de las desventajas de realizar los exámenes de certificación de las especializaciones médicas mediante casos clínicos seriados y analizarlos con la Teoría Clásica del Test (TCT). Los exámenes de certificación de las especializaciones médicas corresponden a exámenes sumativos criteriales de altas consecuencias, por lo tanto, es imperativo mantener los máximos estándares de calidad en todos los procesos implicados en su elaboración. Actualmente, se ha detectado que algunos consejos de especialidades médicas realizan los exámenes de certificación con pruebas que incluyen casos clínicos seriados y que el análisis psicométrico está sustentado en la TCT; sin embargo, la estructura de este tipo de pruebas infringe los supuestos fundamentales de dicha teoría. La violación de los supuestos fundamentales de la TCT en las pruebas construidas mediante casos clínicos seriados puede conducir a sesgos o interpretación errónea de los resultados. Por lo anterior, es recomendable utilizar otros modelos psicométricos para el análisis de este tipo de pruebas, o evitar el uso de los casos clínicos seriados en los exámenes de certificación de las especialidades médicas.